JOY Project Enrolment Form Order Number First Name * Last Name * Date of Birth * Age Email Address * Address * Ownership of Property Own Property Private Rented Housing Association (Fortis, Nexus, Rooftop, Sanctuary) Other (Please add below) Postcode Other Home Phone Number Mobile Number * Email Address Emergency Contact Details: Add Name and Phone Number Relationship Are you currently? (please tick) Working Full Time Working Part Time Studying and Working Unemployed (unregistered) Unemployed (registered) Other (please specify) Please Specify Are you currently working with any other agencies? YESNO Are you currently in receipt of State Benefits YESNO Do you have any disabilities or long term medical conditions or dietary requirements that we should be aware of? (eg epilepsy, diabetes) YESNOPREFER NOT TO SAY Why are you interested in the Joy Project? * Coffee Drop in's Courses Volunteering / Mentoring Learn new skills To meet people Other It would be really useful if you could give us some details on your cultural origin, religion and sexual orientation. Thank you for your help Ethnic Origin - White British Irish Gypsy / Traveller Any Other White Background Ethnic Origin - Black or Black UK Caribbean African Any Other Black Background Ethnic Origin - Asian or Asian UK Pakistani Bangladeshi Indian Chinese Any other Asian Background Any other Ethnic Groups Prefer not to Say Prefer Not to Say Religion or Belief No Religion Christian Hindu Muslim Jewish Buddhist Sikh Other Prefer Not To Say Sexual Orientation Heterosexual Lesbian / Gay / Bisexual TO BE COMPLETED BY EVERYONE - Our aim of JOY is to inform you of choices that are available to you and to support you in whatever choices you make with a view to enhance your future. I certify that the information set out in this enrolment form is, to the best of my knowledge, accurate and complete. I give permission for anonymised information about me to be used by Worcester Community Trust for the purpose of monitoring and in accordance with the Data Protection Act. I understand that the information about me will be confidential unless I give my permission for it to be used with others. Signed * I hereby give Worcester Community Trust permission to use and reproduce the photographs of myself taken as part of the JOY Project. This permission includes reproduction for any reasonable purpose, including WCT publicity, in printed or electronic media. Signed and Date
